Provider Demographics
NPI:1255800892
Name:GORSKY, MARVIN
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:GORSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 S FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-6392
Mailing Address - Country:US
Mailing Address - Phone:973-509-9777
Mailing Address - Fax:973-509-9888
Practice Address - Street 1:33 S FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-6392
Practice Address - Country:US
Practice Address - Phone:973-509-9777
Practice Address - Fax:973-509-9888
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014222001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical